1. Ultrasound by ICU Nurse
Sanjeev Bhoi MD FACEE
Additional Professor
Department of Emergency Medicine
AIIMS Trauma Centre

2. 0730hrs ICU
44 yrs old presents to the
ICU with Motor Vehicle crash .
Arrival Vital Signs
BP: 80/64mmHg,
HR- 130,
RR-24,
Confused, cold and clammy
How will you manage the patient??

3. Initial Assessment and Management
• Triage-Red
• Primary Survey
• FAST
• Secondary Survey
Treat first that kills first

4. Why US in EMED?
TIME CRITICAL
In a disease in which there is
a golden hour, every
minute counts!
AUTLS

5. Point of Care Ultrasound
• Goal Directed
• Highly focused
• Limited Examination
• Binary questions
• Binary answers

6. Who should be doing in acute care?
Journal of Emergencies trauma and Shock ,January 2013

7. who should be doing in ED?
Non-radiologist vs Radiologist

8. Ultrasound Algorithm
9/30/2013 ITC-2012
AUTLS

9. A
9/30/2013 ITC-2012

10. B
9/30/2013 ITC-2012

11. 9/30/2013 ITC-2012

12. Pneumothorax
9/30/2013

13. C
9/30/2013 ITC-2012

14. THE RUSH EXAM
Leaking tank
Internal blood loss –
Haemothorax / Hemo-peritoneum (Hypo-volumic shock) in trauma by
FAST exam (Focused Assessment with Sonography in Trauma)
(ED sensitivity - 92% & specificity - 100% for hemothorax)
How much fluid can FAST detect?
• 250 cc total
• 100 cc in Morison’s pouch

15. D
E
9/30/2013 ITC-2012

16. DISABILITY
AUTLS

17. • ASSESS PUPIL AND PUPILLARY REFLEX

18. Seeing through Closed Eye

19. Pupillary size

20. ICP RAISED ?

23. Optic Nerve Sheath Diameter
AUTLS

24. OUT OF PLANE

26. IN PLANE

28. ACUTE CARE SONOGRAPHY FOR NURSES
Brachial pl. Block in ED
Sea-Shore sign

29. “Unlearn and keep Learning”